摘要
背景:肱骨远端骨折常为粉碎性且解剖结构特殊,其复位及固定非常困难,何种手术入路处理此骨折更具有优势在目前临床研究中仍存在争议。目的:对比分析两种肘后入路双垂直锁定钢板内固定修复肱骨远端C型骨折的疗效。方法:将符合标准的32例肱骨远端C型骨折患者根据手术入路分为2组,尺骨鹰嘴截骨入路组18例,肱三头肌舌肌瓣入路组14例,确定2组患者在年龄、损伤机制、骨折分型等方面差异无显著性意义。对患者的手术时间、术中出血量、住院时间、愈合时间及术后随访功能及并发症的发生情况进行统计,术后1,3,6个月、1年及1年半随访。根据临床检查及影像学检查记录骨折愈合时间及并发症,术后1年采用Mayo评分评价肘关节功能。结果与结论:①尺骨鹰嘴截骨入路组患者较肱三头肌舌肌瓣入路组手术时间更长、术中出血更多(P<0.05),但是预后肘关节屈曲及伸展角度更大(P<0.05),术后1年肘关节功能更优(P<0.05);②两入路在骨折愈合时间等方面差异无显著性意义(P>0.05);③综上,肘后两种入路均能良好显露肱骨远端骨折关节面,双垂直钢板能够有效固定肱骨远端C型骨折。肱三头肌舌肌瓣入路术中损伤更小,尺骨鹰嘴截骨入路预后拥有更好的肘关节功能和更少的并发症。
BACKGROUND： Distal humerus fracture is often comminuted, and is difficult to receive reduction and fixation due to its special anatomical structure. Choosing which surgical approach is still a controversy.OBJECTIVE： To compare and analyze the curative efficacy of the perpendicular double-locking plating system for the internal fixation of type C distal humerus fractures through two kinds of postcubital approaches.METHODS： Thirty-two cases of type C distal humerus fractures were enrolled and divided into groups A （osteotomy of olecranon approach） and B （tricep anconeus flap approach）. There was no significant difference in the baseline data between two groups. The operation time, intraoperative blood loss, hospital stay, healing time,postoperative follow-up and complications were recorded and analyzed. The patients were followed up at 2 weeks, 1, 3,6, 12, and 18 months. The healing time and complications were recorded according to radiographs and physical examinations. The Mayo Elbow Performance Score was used to determine the elbow function at 1 year postoperatively.RESULTS AND CONCLUSION： （1） The group A had a longer operation time and more intraoperative blood loss than those in the group B （P 0.05）. （3） These results suggest that the articular surface of the distal humerus fracture is displayed well through two approaches, and the perpendicular double-locking plating system for the internal fixation of type C distal humerus fractures is rational. Noticeably, the tricep anconeus flap approach dose little damage to the muscle, while the osteotomy of olecranon approach obtains better elbow function and less complications.
出处
《中国组织工程研究》
CAS
北大核心
2017年第27期4324-4329,共6页
Chinese Journal of Tissue Engineering Research
